CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help?

My father was admitted to hospital with pneumonia and difficulty swallowing. Then he aspirated his food and was given a ct scan that said he has widespread cancer. Now, about a week later he seems to have recovered from the pneumonia, but he is very weak, he's 91, and only on a saline iv. I'm told that the cancer is aggressive and that he won't recover. He never complained of any pain in his stomache, where the cancer is supposed to be & because he can't swallow, he isn't getting any nutrition. Also, there is a mass in his esophagus, and I was told that's cancer too, even though there hasn't been any biopsy done at all on any part of his body, just the one ct scan. He is fighting very hard to recover and is much more vital than his age would indicate. My question is: Would a feeding tube help, at least to give him a chance, to try to recover & should there have been a biopsy done? (One cancer site was right above his bellybutton, a little protruding bit which would be easy to biopsy. He won't last very long just on saline, and I keep asking for a feeding tube because it's awful to just starve him. Please tell me if a feeding tube would give him a better chance to recover. Thanks

Brief Answer:
Naso-jejunal feeding or total parenteral nutrition
Detailed Answer:
Namasthe
Welcome to Healthcare-Magic
Greetings of the day
Naso-jejunal tube feeding will definitely be more beneficial than just giving intravenous fluids, provided there is no obstruction in the oesophahus and gastrointestinal tract. As you have not mentioned the site of origin of tumor. Naso-jejunal tube feeding will bypass the stomach and hence decrease the chance of aspirations from occurring.
If the cancer is originating from oesophahus and the tumor is obstructing the lumen and insertion of tube is not possible , in such a case Total Peripheral or central parenteral nutrition can be the option.
I would like to go for either Naso-jejunal feeding or a Surgically created Feeding Jejunostomy tube if there is any obstruction.
I hope it helped.
Take care
Regards

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 17 hours later

Thank you Dr.Kaltari.
Yes there is a mass obstructing my father's oesophagus, but no obstruction in his stomach, but they say his abdomen has several "ascites" and "omental caking" just above his bellybutton. And they say, from the ct scan, that his abdomen has "carcinitomas", cancer spread throughout his abdomen.
Also, I have been trying to get the Doctors to do the parenteral feeding, but they refuse to do it and say "it would just be feeding the cancer" , and he will not recover even if they feed him, which does not sound right to me, he should be fed and given at least a chance to get better because he is starving.
What do you think of that statement, "it would just be feeding the cancer" ? Please let me know Dr.Kaltari.

Answered by Dr. Deepak Kishore Kaltari 6 hours later

answer Id 279698; conversation id 258975

Brief Answer:
Fasting not the solution
Detailed Answer:
Namaste
Greetings of the day
It is advanced Carcinoma as per CT report. Looking at his age and Stage IV of tumor further intervention for the tumor either for biopsy or management will be futile.
Every living person has right to live life with dignity and starvation is definitely not ethical.
I see many patients with terminal cancer, I personally tell the parents that any intervention for tumor is futile. I give them the option for elemental nutrition by either Naso-jejunal feeding or Surgical feeding jejunostomy. Parenteral nutrition is not advisable as it has high complication rate which may even shorten life.
I hope it helped.
Take care
Regards

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 10 hours later

Thanks Dr.Kaltari.
As you said in your first reply, he would not be able to do the naso-jejunal feeding because of the "mass" blocking his esophagus.
Will you please explain to me what the "surgical feeding jejunostomy" is, and if this is the only nutritional option for him?
Also, would it be possible to feed him through the IV that is already inserted in his vein in his hand?

Answered by Dr. Deepak Kishore Kaltari 20 minutes later

answer Id 279700; conversation id 259225

Brief Answer:
Only short term nutrition possible through iv
Detailed Answer:
Greetings of the day.
Nutrition through Peripheral venous line can be only used for few days, as the veins will undergo thrombosis and will not be able to tolerate high glucose concentration used for total parenteral nutrition. Even if the veins are changed, on an average nutrition can be possible through veins only for 2 weeks.
Feeding Jejunostomy is done either by Laparosopic or open surgery, in which abdominal cavity is approached by above route respectively. A tube is tunneled through the jejunum and the other end of the tube is brought outside through abdominal wall, through which feeding can be given.
It's a invasive procedure and requires patient to be fit for surgery and risk of General Anaesthesia
I hope it helped.
Take care
Regards

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 9 hours later

Thank you Dr.Kahltari for explaining the jejunoscopy methods/procedures.
My father is not able to have the naso-jejunal feeding because of the "mass" in his esophagus, which at this stage they will not attempt to get rid of, because he is too weak.
He is now too frail/weak to have general anesthesia, so cannot have the surgical feeding jejunostomy either by laparascope or open surgery.
You also said IV feeding would only be possible for about 2 weeks, maximum.
Since he has the mass in his esophagus and is too weak/frail for general anesthetic, please tell me how to get him some nutrition?

Answered by Dr. Deepak Kishore Kaltari 3 hours later

answer Id 279702; conversation id 259536

Brief Answer:
Central line parenteral nutrition
Detailed Answer:
Greetings of the day
Only option is giving nutrition through a Peripherally inserted Central line(Through the Femoral Vein in the thigh) or Using Central line like Central line Catheter inserted in Internal Jugular vein in neck.
I hope it helped.
Have a wonderful day.
Regards

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 40 hours later

Thank you Dr.Kaltari, this is very much appreciated.
I'm having an awful time trying to get this done for my father.
When either of these feeding methods, in our last message, is used, will it be painful to insert the tube & how long can he be fed this way?

Answered by Dr. Deepak Kishore Kaltari 13 minutes later

answer Id 279704; conversation id 260461

Brief Answer:
There is no discomfort in the procedure
Detailed Answer:
Greetings of the day
Central line can be inserted in sterile environment under local anaesthesia or if preferred by Surgeon then short general anaesthesia can be used. It's not painful and is well tolerated by patients. Well maintained central line can last for couple of months or even longer.
I hope it helped
Wishing you success.
Do take care of your Health too. Things will be fine soon.
Take care
Regards
Dr Deepak Kaltari

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 14 hours later

Thank you for the details and your kind words.
Earlier in our conversations, I think in your 2nd reply, you indicated that parenteral nutrition would not be advisible because of the high complication rate. However, in your last reply, you said it would last a couple of months, if well maintained. Since this is the only feeding option left for my father, I have repeatedly asked the many Drs. that come in for a few minutes a day & they won't do it, because they say "it will only feed the cancer"
I find this unethical, and cruel, just to have my father on a saline iv and dilaudin (he now sleeps most of the time, because of so much dilaudin) He was still very alert and responsive until they gave him so much of it, plus he told me that since recovering from the pneumonia, he has no pain.
Just 4 months ago he had a complete physical, bloodwork, urine, and a chest x-ray, can you please tell me why his "widespread" cancer would not be detected then, and what do they mean by if they fed him, it would only be feeding the cancer?

Answered by Dr. Deepak Kishore Kaltari 18 minutes later

answer Id 279706; conversation id 260789

Brief Answer:
Spread to other Organs before occluding the lumen
Detailed Answer:
Namaste
Greetings of the day
Internal cancers are detected if they cause symptoms. In cause of Oesophageal cancer it would have spread to other Organs like abdominal cavity before it could obliterate lumen of oesophageal to cause symptoms. Chest Xray or blood test cannot pick up oesophageal cancer.
I do not agree that one should not feed the patient as one is feeding the cancer. Starvation is not the solution for advanced cancer. We have to respect the emotions and maintain the dignity of human life. I would let my patient die of advanced malignancy than starving him.
Pain control and nutrition are the palliative measures for advanced cancer.
It's upto you to convince the treating physician.
All that any physician can provide at this stage is supportive and sympathy care.
Take care
Regards

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 3 days later

Doctors refuse to listen to me. They are starving my father, no matter what I say, they keep saying feeding him will only feed the cancer. They moved him from ICU to palliative care. I want to thank you, Dr. Kaltari, for your compassion and information, more than I am getting from this rotation of Dr.s here that have lost sight of basic humanity.
Please tell me, the one ct scan that diagnosed my Dad with "widespread cancer", ascites, omental caking, carcinitomas,etc: Is one ct scan interpretation/report, absolutley proof that my Dad definitely has cancer?
Thank you Dr.Kaltari.

Answered by Dr. Deepak Kishore Kaltari 8 minutes later

answer Id 279708; conversation id 262438

Brief Answer:
Diagnosis based on Clinico Radiology correlation
Detailed Answer:
Namaste
Welcome to Healthcare-Magic
Greetings of the day
I am very sorry for the state of affairs of your father. My sincere sympathy is with you.
Presence of omental thickening, severe ascitis and a lesion in oesophagus along with symptoms definitely points towards advanced cancer. Diagnosis is purely on Clinico Radiology correlation. Tissue diagnosis is not done in majority of such cases when the primary source of tumor is known and the cancer is advanced. Only palliative care in form of pain control and nutrition is all that can be provided.
God bless everyone of us.
Take care
Regards

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 43 hours later

Thanks Dr.Kaltari
Since my father was moved to the palliative careunit, still only on a saline IV and now dilaudin every 6 hours, he sleeps constantly and only moans whenever the nurses turn him or bathe him. The last thing he said to me was "what happened?" and I just told him he is very sick, b. ause even though one of the Drs. told him several days ago he has cancer, he still believed he would be well enough to go home. He was alot more active than most people his age, and even just on saline and antibiotics he recovered from the pneumonia.
My question is, in your experience, is the ct scan Report/Interpretation ever incorrect? Even without food he got over the pneumonia and I will feel guilty forever because I couldn't get the Drs. to feed him. He's fading now, it's been so long without food, even a healthy person wouldn't survive. Please tell me,in your opinion, is the ct report/interpretation is always correct for widespread cancer and do you think my father is in pain, even though he is so drugged up that he is always asleep now?
Thanks Dr.Kaltari

Answered by Dr. Deepak Kishore Kaltari 20 minutes later

answer Id 279710; conversation id 263514

Brief Answer:
CT scan denotes widespread cancer
Detailed Answer:
Greetings of the day
I am very sorry to know the state of affairs going on.
In my experience the CT findings would definitely suggest stage 4 terminal cancer with the known primary being in the oesophagus. So the diagnosis is based on both clinical and Radiological correlation and usually right for advanced cancer.
Tissue diagnosis is attempted when the primary source of tumor is not known or one plans for chemotherapy.
He is been on dilaudin which is apomorphin a Opioid analgesic. That is usually used for treatment of advanced Cancer pain which occurs due to entrapment of nerve in late stage. He is sleeping the whole day due to sedation caused by drug.
Give your dad love and moral support.
I pray that the things tend to get better.
God bless us all.
Take care
Regards
Dr Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 3 days later

Thank you for your kindness and answers, Dr. Kaltari.
My father has now been denied any nutrition for 3 weeks. I've been with him day and night, ever since the 2nd day of his hospitalization, and it just breaks my heart to see him slowly wither away.
They stopped the saline IV yesterday because his liver is shutting down and the Drs. say that fluid is in his lungs. This is a horrible way to die and my father was kind and good, his whole life and this is unfair.
He is making awful noises and struggling to breathe because of fluid in his lungs. He is still on dilaudin. His eyes are 95% closed, but he keeps looking at me and looks so afraid, his eyes open just a very little.
He started to just take a small inhale and long exhale breathing.
Please tell me, is this awful gasping for air very painful,, he is on dilaudin, and if he had been fed would his last hours have been like this, or easier for him?

Answered by Dr. Deepak Kishore Kaltari 10 minutes later

answer Id 279712; conversation id 265179

Brief Answer:
Enteral Nutrition less complication
Detailed Answer:
Namasthe
It feels extremely terrible to know the state of affair of dad.
Enteral Nutrition ie feeding through the gastrointestinal tract is always better than giving it intravenously as only the required amount of fluid is absorbed from intestine unlike intravenous fluid in which there is tendency for volume overload. It is this volume overload which causes retention of fluid in lungs causing Pulmonary Oedema.
Water in lungs that is Pulmonary Oedema makes the lungs difficult to expand and thereby affecting Oxygenation, causing air hunger. It is this air hunger which makes the patient restless and affects the respiration.
To a greater extent this complication of Pulmonary Oedema could have been avoided if he was being feed through some way through gastro-intestinal tract.
Please be with him and provide him all the emotional support he needs, even though he may not be opening his eyes completely, he may still be feeling your presence and support.
Take Care
Kindly get back to me if you need to share anything.
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 2 days later

Thank you for your help, Dr.Kaltari, I wish you had been my Dad's doctor.
My father has passed away and I am heartbroken, he died gasping for air. He was a good man and should not have went in such a unnatural, horrible way.
Dr.Kaltari, you said the oedema, fluid in his lungs was from the IV volume overload.
The Drs. said that my Dad was too weak to have anesthesia, so they couldn't insert a feeding tube through his nose or abdomen.
Will you please tell me, if he had been fed through the Peripherally inserted central line, or the Central line catheter into the jugular vein, would the fluid volume overload and pulmonary oedema still have happened? Those were the only possible feeding options without anesthesia. Please let me know.

Answered by Dr. Deepak Kishore Kaltari 1 hour later

answer Id 279714; conversation id 266713

Brief Answer:
Pulmonary oedema can occur with Iv and Jugular lin
Detailed Answer:
Dear I am extremely sorry for sad demise of your father. I pray his departed soul rest in peace.
Pulmonary oedema due to volume overload is known complication of parenteral nutrition either given through Intravenous or central line. Even a little extra Iv fluid given to individual with associated comorbid condition like widespread cancer and old age can lead to oedema. It depends from person to person, how much reserve the body has to handle the extra fluid.
I pray to God that he gives you and your family strength and endurance to overcome the grief of demise of your beloved father.
God bless you and all of us.
Take care
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 2 days later

Thank you Dr.Kaltari, XXXXXXX I truly appreciate all of the answers and compassion that you have given to me.
I still believe my father suffered more because of being denied nourishment. I believe he was given so much dilaudin to keep him semiconscious until his body shut down from starvation and the fluid overload from the saline IV.
I never want to see anyone pass away in such breathing distress again, it took about 12 hours, and the last few minutes were so heartbreaking, I was so afraid I could not even speak to my father and I feel so guilty about that.
Will you please tell me, if he had been fed peripherally, and not given so much dilaudin (he told me he wasn't in any pain, he said), would he have lasted longer and would it have been a less painful death?
Thank you, and bless you.

Answered by Dr. Deepak Kishore Kaltari 44 minutes later

answer Id 279716; conversation id 268465

Brief Answer:
Dilaudin is required for pain management
Detailed Answer:
Namaste
Greetings of the day
I'm extremely sorry for the state of affairs of father.
Denying Opioid analgesic like Dilaudin to terminally I'll cancer patient is unethical. It's a basic human right and dignity to be given analgesic. Usually the dose is titrated according to every individual. The aim is to treat or suprees the pain in the earlier stage itself.
As you told me he was not in any pain, that is a really good thing. The misery of any terminal cancer patient is pain and relieving it the duty of treating physician.
Dilaudin is also one of the drug used in management of pulmonary oedema too.
I pray that God gives you and your family the courage to go about his demise. I do understand how disheartened and helpless one feels seeing their loved ones to go away from them. Life has to go one. You have to take care.
With all the prayers
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 2 days later

Hello Dr.Kaltari and thank you for all your answers concerning my father.
I wish he had been strong enough to tolerate the anesthetic needed for the direct gastrointestinal placement of a feeding tube. It probably would have been better to risk the operation, less suffering.
It is the starvation and pulmonary oedema that killed him, not the cancer, which makes his death even more tragic. He was active, even still driving his car, until he came down with pneumonia about 6 weeks ago. He even recovered from that, in hospital while only on saline and intravenous antibiotics. He should have been fed, as you said earlier, even just on a saline iv he did not pass until 3 weeks of no nutrition. It breaks my heart that while he was slowly starving, he also got the pulmonary oedema which took a long night of struggling to breathe, a terrible way to die.
I need to know, in your opinion, if he had been fed peripherally, would his passing have been easier?

Answered by Dr. Deepak Kishore Kaltari 2 hours later

answer Id 279718; conversation id 269916

Brief Answer:
Long term parenteral nutrition has its own complic
Detailed Answer:
Namaste
Greetings of the day
I'm sorry for taking more than one hour to reply since you asked the question, I was operating. Apologies.
As you are aware that he was not able to take anything orally and also was not fit for anaesthesia for introducing a gastrointestinal line like Jejunostomy. The only option was Peripheral intravenous nutrition, And fluid overload and electrolyte disturbance become inevitable consequences when given for more than couple of week. I agree pulmonary oedema had caused him a lot of suffering because of air hunger.
The best mode of feeding would have been through gastrointestinal tract, any other modality of feeding has its own complication.
Wishing you a healthy life
Take care
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 3 days later

Greetings Dr.Kaltari, thank you for your help.
As you know, my father was only on a saline if for 3 weeks, no nutrition given.
I need to know, in one of your answers, dated Oct.17,2013, you said a well maintained periphally inserted, no general anesthesia needed for insertion, feeding line could last a couple of months, or longer.
Would my father have suffered less if this had been done?
I need to know.
Thanks

Answered by Dr. Deepak Kishore Kaltari 17 minutes later

answer Id 279720; conversation id 271733

Brief Answer:
Pulmonary oedema could be sequelae in central line
Detailed Answer:
Namaste
Greetings
I had mentioned about central line and not Peripheral line which can last couple of months. In central line lipids and amino acids can be given apart from given glucose. It gives more diet support. At same time it has its own inherited complication like Central line sepsis especially if used in advance malignancy, electrolyte and metabolic derangement etc.
It would have just controlled the nutritional support more appropriately as compared to Peripheral line. Pulmonary oedema is known consequences or sequence of any parenteral nutrition be it central line or Peripheral line.
The basic indication of using any line is nutritional support, at the expense of risking fluid overload. The complication could still have occurred with central line too. I had mentioned it because it can be maintained longer than the Peripheral line.
I hope I have cleared your doubts.
Have a good day.
Will be available to assist in case you have any other query.
Take care
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 2 days later

Thank you Dr.Kaltari for explaining about the central line.
Please tell me, if he had been given the central line, would he have suffered as much during the 21 days that he was only given saline?
Thanks

Answered by Dr. Deepak Kishore Kaltari 3 hours later

answer Id 279722; conversation id 273595

Brief Answer:
nutrition would have been well maintained
Detailed Answer:
Greetings
His nutrition and general conditions would have been well maintained with a properly maintained central line.
The major drawback is it requires proper care and biochemical monitoring of blood biochemistry.
I hope it helped.
Take care
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 3 days later

Thank you again Dr.Kaltari.
I'm rewriting this because it didn't get processed.
I was originally told that my Dad had a mass in his esophagus and widespread cancer.
I now have the ct scan reports and am worried about the findings.
One says he had thickening in his distal esophagus with a large mass approximately 3.4cm x 3.3cm in the posterior aspect. An endoscopy was recommended, but never done because he aspirated his pureed food on the 2nd morning in hospital.
Also, there was a 7cm lobulated intraluminal mass within the cecum and ascending colon spanning the ileocecal valve with no bowel obstruction and both small and large bowels were normal in caliber.
Please tell me if the mass in his esophagus could just have been inflammation from pneumonia, or some other reason? Are masses always malignant? I was never told about the mass in his cecum, would that have been painful?
Because these measurements are in centimeters they seem so small, could he have possibly recovered?
Sorry for asking but I am very upset.
Thank you and bless you Dr.Kaltari

Answered by Dr. Deepak Kishore Kaltari 2 hours later

answer Id 279724; conversation id 275626

Brief Answer:
Pneumonia will never affect oesophagus
Detailed Answer:
Namaste
Greetings
Presence of intraluminal mass in oesophagus associated with thickening of wall along with obstruction is likely to be cancer. Pneumonia never affects oesophagus, even in severe cases.
In my view endoscopy was not attempted because of poor general condition and presence of widespread metastasis. Much significance cannot be attached to incidentally detected caecal lesion in absence of obstructive symptoms.
I hope it helped.
Take care
Regards

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 2 days later

Thank you for all your excellent information during this terrible time.
Dr.Kaltari, if my father had been your patient, what would your treatment have been?

Answered by Dr. Deepak Kishore Kaltari 3 hours later

answer Id 279726; conversation id 277533

Brief Answer:
gone ahead with Jejunostomy
Detailed Answer:
Namaste
Greetings
I would have gone ahead with open or laparoscopic feeding Jejunostomy. Rest left to god and mother nature.
Take care
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 2 days later

Hello and thank you Dr.Kaltari.
Yes, that probably would have been more humane.
If he had been fed through a central line for several days before , do you think that would have built up his strength and given him a better chance at surviving the open or laparascopic feeding jejunostomy?

Answered by Dr. Deepak Kishore Kaltari 3 minutes later

answer Id 279728; conversation id 278784

Brief Answer:
central line nutrition would have been good option
Detailed Answer:
Namaste
Greetings
Nutrition through central line with proper monitoring of the line to avoid complication would definitely given more support. I agree with what you have said.
Wishing you and your family good health
Take care
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 3 days later

Thank you, Dr.Kaltari, for all your help during my poor father's illness. Much better than the Dr.s here, who don't seem to listen or care about elderly patients and have lost their basic respect for dignity.
Would you please tell me, because my Dad had cancer of the esophagus, am I more likely to get this disease, and are there any symptoms I should watch for,or medical tests that I should have done, and at what age?
Thank you , you've been very comforting and your information has meant very much to me.

Answered by Dr. Deepak Kishore Kaltari 2 hours later

answer Id 279730; conversation id 280618

Brief Answer:
endoscopy even in presence of heartburn
Detailed Answer:
Greetings
Oesophageal cancer does not run in family and there is no cause of concern to other family members.
The precautions indicated for general population apply to everyone for early diagnosis of oesophageal cancer
1. Any individual above the age of 40 years who is presenting with heartburn , difficulty in swallowing food, pain during swallowing food should have atleast a upper Gastrointestinal endoscopy done to rule out any lesion in oesophagus and stomach.
2. Oesophageal cancer in majority arise from pre-existing ulcer or oesophagitis which is usually due to acid reflux, if during endoscopy ulcer is found at any time, it is important to put them patient on surveillance by regular endoscopy to document resolution of the pathology when the patient it's started on treatment.
I hope it helped
Wishing you and your family healthy life
Take care
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 3 days later

Dr.Kaltari, thank you, you are a great help with all the information.
I also wanted to ask you, because I forgot to mention that my father had acid reflux for at least 15 years and was on a prescription for it (I can' remember the name of the drug) and he was rapidly losing weight in the 3 months prior to his hospital admittance.
Should his Dr. have suspected cancer because of the extreme weight loss, about 8 pounds per month, and history of relux, and he had a approximately 2inch skin cancer on his back that never healed kept scabbing and breaking open in a 8 year timeframe, and ordered some sort of tests?

Answered by Dr. Deepak Kishore Kaltari 10 minutes later

answer Id 279732; conversation id 282398

Brief Answer:
Should rule out malignancy in case of weight loss
Detailed Answer:
Namaste
Greetings
Any weight loss of more than 10percent of body weight in a duration of 6 months is considered as significant weight loss. Your father had weight loss.of 8 lb per month it's quite significant. Also a individual with history of reflux should be periodically assessed for change in symptoms or development of new symptoms. Depending on every individual periodic assessment by upper Gastrointestinal endoscopy may be required.
And elderly patient presenting with significant weight loss. One should consider the possibility of malignancy and rule it out. Also father had associated reflux symptoms, in view of it I've should rule out oesophagus malignancy.
Regarding management of non healing skin lesion, the least possibility investigation to be done is atleast punch biopsy if the lesion is big or excision biopsy for confirmation of.Diagnosis. confirmation of malignancy requires histopathology examination.
I hope it helped
Kindly get back to me if you have any other query
Take care
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 3 days later

Thank you again, Dr.Kaltari, for your help and knowledge.
A dermatologist did do repeated cutting out of the affected area on my Dad's back, which never healed over the course of several years & told my Dad it was a very slow moving squamous skin cancer and not to worry about it.
Also, exactly a year ago, before his final illness this year, he was very sick with what his Dr. said was the Shingles virus, bedridden for almost 3 months. He suffered a lot, and developed fecal impaction which lasted a few weeks & was corrected by enemas administered by my Mother, because he was against going to hospital.
After recovering, he regained the 10 or 15 pounds he had lost, and was doing very well. He still worked in his garden and drove my Mom everywhere. He had a period of about 9 months of good health, until he started to rapidly lose weight, began to have difficulty swallowing, and
contracting pneumonia, and even then did not want to be hospitalized until he was had to, because he was having a lot of breathing difficulty. But even just on antibiotics and saline he recovered from the pneumonia, but still could not swallow, and as you know, was not fed.
My question is, could the fecal impaction, or the squamous cell skin cancer have caused the esophageal cancer and, also, in your opinion, about how many months would it take to develop to this stage?
Sorry for the long message, but I wanted to say all the facts. Thank you Dr.Kaltari, for helping me to try to understand how this happened to my father, who had been healthy his whole life.

Answered by Dr. Deepak Kishore Kaltari 1 hour later

answer Id 279734; conversation id 284123

Brief Answer:
oesophagus malignancy unrelated to skin or fecal
Detailed Answer:
Greetings
I appreciate such detailed information and there is no need of being sorry.
Squamous cell carcinoma of skin and fecal impaction are just coincidental associated findings and bear no control over occurrence of oesophageal malignancy.
It takes atleast 18 to 24 months for the growth of oesophagus to grow to the size of occluding the lumen of oesophagus completely and cause obstructive symptoms like dysphagia.
Fecal impaction is usually age, diet related(consumption of less water and low fiber diet) and decreased physical activity related problem.
Squamous cell carcinoma usually spreads to the regional lymph node draining that particular area of skin and is unlikely to spread to internal organs.
I hope it helped
Do get back to me if you have any other query
Take care
Regards
Deepak

Follow-up: CT scan showed wide spread cancer. Having mass in esophagus. Should biopsy be done? Does a feeding tube help? 3 days later

Thank you, Dr.Kaltari, again for your answers.
If my father had been given an open, or laparoscopic jejunostomy and had been fed that way it would have been so much less suffering for him.
Originally, they were going to put a stent in his esophagus, but after he aspirated his food, and we got the ct results, they said he wasn't strong enough. They just gave up on him, I think it was because of his age, and starved him, with just a saline iv, and I think he was given way more dilaudin than necessary, but at least it kept the pain of starvation away, I hope.
Would he have been strong enough, if he had been given the jejunostomy to be able to speak to us during his final days and was there any chance, in your opinion, that he could have recovered enough to have the esophageal stent and possibly even to go home?
( I must mention that he had a very strong will to live and was an optimistic person, and even while so sick, said to me that there were better days ahead. I just wanted you to know that he would've never given up and if he'd been fed, at least he'd have had a chance.)
Please let me know what your opinion is about the questions and thanks.

Answered by Dr. Deepak Kishore Kaltari 5 hours later

answer Id 279736; conversation id 285812

Brief Answer:
General state would have been better
Detailed Answer:
Namaste
Greetings
It's really nice to know the love and concern you have for your dad.
Feeding jejunostomy would have given him more time,as the nutrition is maintained his general condition would have been better during his end of time.
Stent is only for bypassing the obstruction and giving him symptomatic relief. Stenting could have been done.
But it would not have altered the end result, as he had widespread metastasis to other organs.
I am sorry for sad demise of your father. It would now be appreciable if you could overcome the grief.
I wish you and your family a happy and healthy life
Take care
Regards
Deepak